Overview
The inner ear (hearing and balance organs) is
encased in bone and communicates with the middle ear (the space behind the ear
drum) in two locations. These two areas are covered with a thin membrane and are
termed the round and oval windows. If for some reason a communication develops
between the inner ear fluid and the middle ear space, it is called a
perilymphatic fistula. See
Anatomy of the Ear
for reference.
The leakage of fluids from the inner ear can cause hearing loss (either mild or severe) which may be fluctuating, ringing in the ears, and dizziness. These symptoms are worsened with any pressure change.
Once the diagnosis has been established, the treatment is by performing a surgery and repairing the site of the leak.
Presenting Symptoms
Patients with perilymph fistula presents with a sudden or fluctuating hearing loss and/or dizziness. The disturbance in balance may be a sensation of rotation (vertigo), lightheadedness, disequilibrium, motion intolerance, or any combination of the above. The symptoms are especially seen with coughing, straining, loud noise, bending over, or with pressure changes, such as in an elevator.
Causes
Perilymph fistulas are most commonly caused by sudden pressure changes such as in SCUBA diving, ascent or descent on a plane, weightlifting among others. Patients who have undergone a stapedectomy operation, are prone to developing perilymph fistulas.
How is a Diagnosis Made?
Generally after a complete history and physical exam, some tests need to be performed to diagnose the cause of facial paralysis. A test of the hearing (audiogram and tympanogram) and a balance test (electronystagmography (ENG)), and other specialized hearing tests (electrocochleography (ECoG)) are performed. A CT scan (special x-ray) of the temporal bone is necessary to ascertain the diagnosis.
Treatment
Treatment of perilymph fistula once the
diagnosis is made is surgical. While bed rest and non-surgical treatment has
been advocated for the treatment of this condition, which risks further
deterioration of hearing and balance function. The surgical procedure, which
takes about 30 minutes, involves lifting up the ear drum through the ear canal
and patching the round and oval windows.
Recovery
The recovery from perilymphatic fistula surgery involves two weeks of no strenuous activity, no lifting over 20 lbs, sleeping with the head of the bed elevated, and no straining. Normal activities may be resumed after that. The chance that the dizziness will improve after surgery is very high, although the likelihood of hearing recovery is low.
